Childhood Brain Injuries

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Many people have the mistaken impression that the human brain becomes fully developed in early childhood, in the same way as the heart or lungs .In fact, the human brain is subject to a high degree of what neurologists have termed ‘plasticity’.

Plasticity means that the neural pathways that make up our brain, and allow us to think, are constantly evolving throughout childhood. The human brain is not fully developed or adult until the early or even mid-20s. Aspects such as impulse control and forward planning are the last elements in the brain to develop, which corresponds to reckless and short-sighted behaviours that are common in those difficult teenage years.

An acquired brain injury (ABI) is a form of brain damage that is associated with an external cause, such as a severe head injury, as opposed to congenital factors (such as genetic conditions).

It is thought that brain injuries stemming from falls, sporting injuries and car accidents, can lead immature brains to “misfire” and can interrupt the development of young peoples’ ability to restrain their impulses and actions.

These types of injuries are thought to be common in teenagers due to a potentially dangerous ‘cocktail’ of general youthful recklessness, alcohol misuse, and increased risk of being the victim of a physical assault – the classic Friday night city-centre drunken brawl amongst young men (and to a lesser extent, young women).

Brain injuries can also occur due to more wholesome pursuits, for instance, head injuries that occur during sporting activities such as football, rugby, cycling and skateboarding. If left undetected and untreated, these types of injuries can increase the risk of young people offending.

Brain development during childhood and adolescence is complex, involving networks of billions of brain cells and several different systems – from those responsible for breathing and heartbeat, through to those enabling complex decision making.

The teenage brain has an adult-like ability to reason, which appears to be well formed at age 16. However, the system which enables adults to balance long-term consequences against short-term rewards, is not yet fully developed.

Also, in adolescents there is a heightened need for “basic reward”, with an increase in reward-seeking behaviour. This can lead to patterns of abuse involving alcohol and drugs.

Traumatic brain injury (TBI) is the most common and most damaging form of acquired brain injury (which can also have other causes, including stroke and infection).

There are two main types of TBI:

an “open” injury, where the skull is penetrated and the brain exposed, such as from a knife wound – which is thought to be least common, which typically leads to injury to a specific area of the brain

the more common “closed” TBI, where there is an injury to the brain from an external force, but it is not penetrated; for example, by a blow to the head, or a car coming to a sudden halt in a crash

These last injuries lead to lacerations and bruising of brain structures, especially if the brain hits the inside of the skull. Internal bleeding can lead to further injury from compression and loss of oxygen to areas of the brain.

“Closed” TBIs may appear to be less dramatic, but they also lead to widespread injury across the brain, these are classified from mild through to severe.

The consequences include loss of memory and concentration, reduced awareness of one’s own and others’ emotions, poor impulse control and poor social judgement. Behavioural problems such as conduct disorder, increased aggression, attention problems and impulse control problems are all prevalent in people with brain injury.

The outcomes after brain injury in children and young people are hard to predict because their brains are undergoing dynamic change. However, an injury to the brain before certain areas have fully developed may mean they never fully mature, or to “misfire”, with recent work showing that the skills developing at the time of the injury may be the most vulnerable to being disrupted.